For the second installment of our semi-regular series that recommends articles, white papers, or issue briefs of importance to RISE members, we turn to a recent opinion piece written by Commonwealth Fund President David Blumenthal and published by STAT. His column looks at the status of the Affordable Care Act and its growing popularity regarding the protection of covering people with pre-existing conditions.

Although the future of the Affordable Care Act (ACA) remains uncertain, one central tenet of the healthcare reform law has become quite popular: protections for people with pre-existing conditions. 

As more Americans embrace the concept of providing health insurance for those with pre-existing conditions, Republicans—particularly those seeking reelection in November—are now backpedaling from their opposition to the ACAs guarantee that Americans with pre-existing conditions should be able to find health care coverage, writes David Blumenthal, president of the Commonwealth Fund, in a recent column for STAT.

But for insurers to offer affordable coverage to the sick, they must have healthy enrollees. And getting those healthy Americans to enroll in ACA plans is difficult to do because of the repeal of the individual mandate and recent actions taken by the Trump administration to destabilize the market. Those actions includereducing cost-sharing payments to insurance companies, which has led to substantial increases in health plan premiums; and allowing the expansion of the sale and renewal of short-term health plans, which may be inexpensive but don’t cover as many medical services and can deny coverage to consumers with pre-existing conditions.

Republican candidates must find ways to embrace the protections for those with pre-existing conditions without appearing too friendly to Democratic ideas. One proposal, writes Blumenthal, is to endorse a mechanism used prior to the implementation of the ACA: accepting a patient’s enrollment into a plan, but not accepting his or her pre-existing condition. For example, a patient with diabetes may be allowed to enroll but the insurance wouldn't cover anything related to diabetes. 

"These and other routes toward coverage for sick Americans will be fiercely debated in the coming years. As we do so, we shouldn't lose track of the profound change in attitude and expectations around health insurance for the sick that will animate this debate," he writes.

Kevin Mowll, executive director of RISE, says Blumenthal’s piece raises important considerations for the debate over pre-existing conditions. And Mowll says it’s easy to forget that there are three aspects that are central to the issue of pre-existing conditions. Consumers, he says, want to know whether they:

  1. Can get accepted to enroll?
  2. Can get covered without exclusions or underwriting rules?  That is, even if accepted, would their coverage and premiums be affected by the pre-existing conditions? The ACA will allow insurers to charge higher premiums to smokers, but it does not allow exclusions.
  3. Can get renewed in the future? 

By fudging on items two and three, Mowll says that politicians can make it appear as if they support the enrollment of people with pre-existing conditions. But he says, they would be supporting an insurance coverage formula that does a disservice to the people in most need of decent insurance coverage.

To learn how other plans are adapting to marketplace changes, check out our upcoming live event, The 12th Risk Adjustment Forum, for innovative strategies to improve risk adjustment programs for Medicare Advantage, Medicaid, and Commercial Plans.